Understanding racial health disparities in America

Nurse-1-1 was founded to increase access to affordable and compassionate healthcare for everyone. Significant racial health disparities exist in our country, particularly for the Black population, and our goal is to decrease these disparities by providing a digital connection to a trusted nurse, whenever, wherever, and for whoever you are. This problem is big and complicated, as exemplified by the fact that Black Americans’ “mortality rates are about 20% higher than those of Whites, resulting in a 4-year lower life expectancy”. Nurse-1-1 hopes to be a part of the solution addressing this public health crisis.

Healthcare innovation often focuses on the well resourced patient rather than the marginalized one. We want Nurse-1-1 to be different. In order to reach underserved patients, we made the decision to provide our digital triage platform for free to Federally Qualified Healthcare Centers. We also help hundreds of uninsured patients a month, keeping many out of the ER and an associated $2,000 bill. We know it will take a village to bridge the enormous gaps in health outcomes that exist across our country, but we all have to start somewhere. It is important to acknowledge there are gaps in healthcare based on race and ethnicity, socioeconomic status, geographic location, disability, and sexual orientation. These gaps aren’t an easy fix and will require change in the way we care for others, not only in healthcare but in all aspects of life.

Here we are in 2020 and we are still fighting for equal treatment and opportunities for all. Nutritious food for all. Clean water for all. Jobs for all. These disparities have been made even clearer as COVID-19 has changed how we approach and access healthcare. We know that a person’s health isn’t just measured by disease—there are many factors to health, such as access to:

  • High-quality education
  • Nutritious food
  • Decent and safe housing
  • Affordable, reliable public transportation
  • Culturally sensitive health care providers
  • Health insurance
  • Clean water and non-polluted air

Disease may be visible and immediate while these other factors have a slower, longer-term impact on a person’s health. But that doesn’t mean they aren’t just as important to a person’s wellbeing. For example, families living in food deserts may be forced to eat more processed, unhealthy foods, leading to higher rates of diabetes, high blood pressure, and heart disease. 

The trickle down effect on health starts with a secure, well-paying job

The COVID-19 shutdown took on an entirely different meaning for those who lost their job and couldn’t provide food for their family. Rates of COVID-19 infections are higher in poorer communities, mimicking healthcare trends generally seen in patients living in poverty. Crowded living spaces due to inadequate affordable housing, inability to afford and access healthy food, and subpar access to healthcare are just a few factors that stem from not having a consistent, well-paying job. These factors increase the risk of contracting an infectious disease such as coronavirus and then exacerbate the associated mortality rates when you avoid healthcare given the associated out-of-pocket costs. 

Chronic conditions more commonly associated with poverty – diabetes, obesity, and heart disease – also are a setup for increased chances of dying from COVID-19. To put it simply, living in poverty worsens your health for many reasons, especially during this pandemic. 

According to the CDC, nearly 25% of employed Hispanic and Black workers are employed in service industry jobs compared to 16% of non-Hispanic Whites. As the pandemic began, this employment sector took the biggest hit, leaving many people of color unemployed at higher rates than their White counterparts. Even pre-COVID, unemployment rates for these segments of the population were not equal. According to the US Joint Economic Committee, historically, the unemployment rate for Black Americans has been approximately twice the rate for White Americans. In 2020, pre-COVID, this continues to be the case: 6.0% for Black workers and only 3.1% for White workers. The trickle down effect on health starts with a secure job. 

It is also quite easy to fall into poverty once unemployed if you lack financial reserves or family members who have the ability to support you. In Boston, for example, the median net worth of non-immigrant African Americans is $8, while it’s $247,500 for Whites. Unfortunately, this enormous disparity did not happen by accident, and instead stems from systemic racial injustices causing immeasurable consequences to the Black community. Whether it be atrocities such as the massacre of Black Wall Street or keeping minority populations from purchasing real estate in desirable areas through redlining, systemic racism has continually prevented wealth accumulation for Black communities

You can’t have good health without proper housing, access to food and health insurance, and a good, stable job.

You can’t talk about health without talking about race

We know that a person’s race contributes significantly to their health. According to US News and World Report, Black Americans are sicker and die younger than their White American counterparts, even when education and income factors are controlled for. This also extends to Black children, who have a 500 percent higher death rate from asthma compared to White children. 

The Journal of Perinatal Education reports that Black women are 2-6 times more likely to die from complications of pregnancy than White women, depending on where they live. Expressed differently, Black expectant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan. Read that twice. 

These poor health findings are not just simply explained by genetics or poverty. We are seeing that persistent discrimination and racism directly impact these disturbing statistics.

COVID-19 exacerbates health disparities for Black communities

According to a recently published article titled COVID-19 and African Americans, Black populations in major metropolitan areas are seeing disproportionately higher rates of COVID-19 cases and deaths. This includes cities like Chicago and states such as Louisiana, Michigan, and New York. They also report that the COVID-19 infection rate in predominantly Black counties in the US is more than 3-fold higher than that in predominantly White counties, and the death rate 6-fold higher. These figures should be terrifying, but may not be that surprising given what we have reviewed thus far. COVID-19 has highlighted the longstanding divide in health between White and non-White Americans. The ability to telecommute and social distance from clean and affordable housing is a privilege that fewer people of color have, thereby resulting in higher infection rates among a community already plagued with higher chronic health conditions.

How racism worsens health outcomes directly

Poor health outcomes in the Black community are shocking. There is no easy way to fix this, especially since the cumulative effect of many years of unjust treatment based on skin color is one of the main contributors to poor health. New research is showing that common, repeated exposure to stress in the form of racism and discrimination causes increased health problems in the Black community. The American Journal of Men’s Health reports the main psychosocial stressors linked to poor health outcomes for Black men include: (a) negative, narrow stereotypes of Black males; (b) interpersonal and structural discrimination; (c) disproportionate poverty, unemployment, and underemployment; (d) residential segregation in investment-poor, underserved, and decaying neighborhoods; (e) inadequate health care; (f) negative interactions with the criminal justice system; and (g) barriers to fulfilling valued masculine roles. Stress in the body can be measured by certain hormones, specifically cortisol levels and patterns. In this same report, it was shown that Black men have cortisol trends that are correlated with poor physical and mental health outcomes as well as an increase in mortality rates as compared to the cortisol levels in those of White men. The American Psychological Association reports that Black adults are more likely to have feelings of sadness, hopelessness and worthlessness than are White adults. Somehow, Black women have increased rates of mortality during childbirth even when health, income and education levels are controlled for. Years of systemic discrimination, everyday racism, and microaggressions continue to increase stress in the Black community, thereby leading to poorer health outcomes.

Improving patient care for Black Americans

Lastly, when we are considering poorer health outcomes for Black Americans, we also have to consider implicit bias and outright racism in healthcare. We’ve seen it throughout history, and we certainly see it today with COVID-19.⁣ A 2012 report found the Black community receiving lower quality of care 43% of the time in measures ranging from quality of annual exams to life threatening treatments for disease. In this particular study, all participants, White and Black, were of the same socioeconomic status with equivalent insurance. Color of skin was the main contributing reason for poor care, and it is thought that racial bias among providers was the contributing factor. 

New statistics coming out during the pandemic show one is less likely to get tested for COVID-19 if they are Black. Check the news and you will see numerous stories of Black men and women dying from COVID-19 without receiving the necessary support or treatment, possibly due to implicit bias

Instead of 2020 being labeled as the year that COVID-19 shut us down, let’s try and make 2020 the year of change, the year that racial bias and injustice ends and health improves for all Americans, regardless of race and ethnicity, socioeconomic status, geographic location, disability, and/or sexual orientation.